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Annual Wellness Visits ‒ Billing Tips for Physicians

After reviewing AWV claim history submitted to the Part B MACs, POE has put together the following tips to help Medicare enrolled physician/providers improve AWV denials by:

  • submitting an AWV before the patient is allowed their next annual visit (frequency), 
  • submitting an AWV when the patient has not been eligible for Medicare for one year (should bill welcome to Medicare), 
  • billing and initial AWV more than once (second and subsequent should be billed as subsequent AWV),
  • duplicate submission of the AWV on one date of service, 
  • submission of modifier with the AWV code (typically modifier 25, not valid), 
  • submitting AWV to original Medicare when the patient is covered by Medicare HMO (submission to wrong contractor) and 
  • separate evaluation and management services can be provided and billed at the same visit as the welcome to Medicare or AWV, provided the services are significant, separately identifiable and medically necessary to treat the beneficiary’s illness or injury.

For more information, visit the Medicare Learning Network® (MLN) Medicare Wellness Visits Tool.

Annual Wellness Visits ‑ Billing Tips for Physicians
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